Hipertansiyon Tanılı Hastalarda Trigliserit/Glukoz İndeksinin İnsülin Direncini Belirlemede Rolü

Year 2024, Volume: 4 Issue: 1, 652 - 660, 25.04.2024

Muhammet Yıldız Habibe İnci Burcu Korkut Pınar Kalem Aysegul Ertınmaz Ozkan Didem Adahan

Abstract

Amaç: Bu çalışmada; kan insülin düzeyine bakılamayan merkezlerde özellikle birinci basamakta takip edilen hipertansiyon (HT) hastalarında insülin direncini tespit etmede Trigliserit-Glukoz İndeksinin (TyG) rolünün belirlenmesi amaçlandı. Gereç ve Yöntem: Bu çalışma kesitsel özelliktedir. Ocak 2020-Ocak 2022 tarihleri arasında üniversite hastanesi iç hastalıkları polikliniklerine başvurmuş, 18-65 yaş arasındaki 458 kişi ile çalışma yapıldı. Bireylerin 285’ i hasta grubunu, 173’ ü kontrol grubunu oluşturdu. Hipertansiyon dışında kronik hastalık tanısı alan ve insülin direnci nedeniyle medikal tedavi alan katılımcılar çalışma dışı bırakıldı. Bireylerin sosyodemografik özellikleri, açlık kan şekeri, trigliserit (TG), alanin aminotransferaz testi (ALT), aspartat aminotransferaz testi (AST), kreatinin, glikozillenmiş hemoglobin (HbA1c), insülin ve tiroit stimülan hormon (TSH) değerleri ile antropometrik ölçümleri hastane otomasyon sisteminden alındı. Bulgular: Çalışmada 285/kişi HT hastasının yaş ortalaması; 52,82±12,60, 173/kişi kontrol grubunun 50,65±13,04’tü. HT hasta grubunun %60,4’ü, kontrol grubunun %59,5’i kadındı. HOMA-IR değeri ≥2,5 olan HT hastalarında TyG değeri için kesim noktası ≥4,78 olarak saptanmış olup duyarlılık %69,1, özgüllük %74,7, ROC eğrisi altındaki alan ± standart hata (AUC±SE)= 0,759±0,030 (p<0,001) olarak bulundu. Yapılan tek değişkenli regresyon analizlerinde TyG değerindeki 1 birimlik artışın hipertansiyon riskini 7,21 kat arttırdığı ve bu artışın istatistiksel olarak anlamlı olduğu tespit edildi (p<0,001). Sonuç: Bu çalışmada TyG indeksinin hipertansiyon tanısı almış hastalarda prognozu etkileyecek bir parametre olarak insülin direncini hesaplamada kullanılabileceği saptandı. Çalışma TyG’nin özellikle aile sağlığı merkezlerinde HOMA-IR’ye alternatif olarak kullanılabileceğine dikkat çeken önemli bir araştırmadır.

Keywords

Hipertansiyon, İnsülin Direnci, Trigliserit/Glukoz İndeksi

Ethical Statement

Çalışma için Karabük Üniversitesi Girişimsel Olmayan Çalışmalar Etik Kurulu’ndan onay alındı (Karar No: 2022/915, Karar tarihi:13/04/2022). Bu çalışma Helsinki Bildirgesine uygun olarak hazırlanmıştır.

The Role of Triglyceride/Glucose Index in Determining Insulin Resistance in Patients Diagnosed with Hypertension

Abstract

Objective: In this study, we aimed to determine the role of Triglyceride-Glucose Index (TyG) in detecting insulin resistance in hypertension (HT) patients followed up in primary care, especially in centers where blood insulin levels cannot be checked. Methods: This study is cross-sectional. The study was conducted with 458 people aged 18-65 who applied to the internal medicine outpatient clinics of the university hospital between January 2020 and January 2022. 285 of the individuals formed the patient group and 173 constituted the control group. Participants diagnosed with chronic diseases other than hypertension and receiving medical treatment due to insulin resistance were excluded from the study. Sociodemographic characteristics of the individuals, fasting blood sugar, triglyceride (TG), alanine aminotransferase test (ALT), aspartate aminotransferase test (AST), creatinine, glycated hemoglobin (HbA1c), insulin and thyroid stimulating hormone (TSH) values and anthropometric measurements were taken from the hospital automation system. Results: The mean age of 285/person HT patients and 173/person control group was 52.82±12.60 and 50.65±13.04, respectively. 60.4% of the HT patient group and 59.5% of the control group were female. In HT patients with a HOMA-IR value of ≥2.5, the cut-off point for TyG value was found to be ≥4.78, with a sensitivity of 69.1%, specificity of 74.7%, area under the ROC curve ± standard error under the ROC curve (AUC±SE)= 0.759±0.030 (p<0.001). Univariate regression analysis showed that a 1-unit increase in TyG increased the risk of hypertension 7.21-fold and this increase was statistically significant (p<0.001). Conclusion: In this study, it was determined that the TyG index can be used to calculate insulin resistance as a parameter that will affect the prognosis in patients diagnosed with hypertension. The study is important research that points out that TyG can be used as an alternative to HOMA-IR, especially in family health centers.

Keywords

Hypertension, Insulin Resistance, Triglyceride/Glucose Index

References

• Bloomgarden, Z,T. (2006). Measures of insulin sensitivity. Clin Lab Med, 26(3), 611-633. https://doi.org/10.1016/J.CLL.2006.06.007.
• da Silva, A.A., do Carmo, J.M., Li, X., Wang, Z., Mouton, AJ., Hall, J.E. (2020). Role of hyperinsulinemia and insulin resistance in hypertension: metabolic syndrome revisited. Canadian J Cardiology, 36(5), 671-682. https://doi.org/10.1016/J.CJCA.2020.02.066.
• Du, T., Yuan, G., Zhang, M., Zhou, X., Sun, X., Yu X.(2014). Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovascular diabetology, 13(1), 1-10. https://doi.org/10.1186/S12933-014-0146-3.
• Gao, Q., Lin, Y., Xu, R., Luo, F., Chen, R., Li, P., Zhang, Y., Liu, J., Deng, Z., Li, Y., Su, L., Nie, S. (2023). Positive association of triglyceride-glucose index with new-onset hypertension among adults: a national cohort study in China. Cardiovascular Diabetology, 22(1),1-12. https://doi.org/10.1186/S12933-023-01795-7/FIGURES/3.
• Gartlehner, G., Vander Schaaf, E.B., Orr, C., Kennedy, S.M., Clark, R, (2020). Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 324(18), 1884-1895. https://doi.org/10.1001/JAMA.2020.11119.
• Hipertansiyon Tanı ve Tedavi Kılavuzu. (2022). http://temd.org.tr/admin/uploads/tbl_kilavuz/20180518104908-2018-05-18tbl_kilavuz104905.pdf adresinden 04 Ocak 2023 tarihinde indirilmiştir.
• Laaksonen, D.E., Niskanen, L., Nyyssonen, K., Lakka, T.A., Laukkanen, J.A., Salonen, J.T. (2008). Dyslipidaemia as a predictor of hypertension in middle-aged men, Eur Heart J, 29(20), 2561-2568. https://doi.org/10.1093/eurheartj/ehn061.
• Minh, H.V., Tien, H.A., Sinh, C.T, et al. (2021). Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension. The J Clin Hipertens, 23(3), 529-537. https://doi.org/10.1111/jch.14155.
• O’Meara, J.G., Kardia, S.L.R., Armon, J.J. Brown, C.A., Boerwinkle, E., Turner, S.T. (2004). Ethnic and Sex Differences in the Prevalence, Treatment, and Control of Dyslipidemia Among Hypertensive Adults in the GENOA Study. Arch Intern Med, 2004; 164(12): 1313. https://doi.org/10.1001/archinte.164.12.1313.
• Ramdas Nayak, V.K., Satheesh, P., Shenoy, M.T., Kalra, S.(2022). Triglyceride Glucose (TyG) Index: A surrogate biomarker of insulin resistance. J Pak Med Assoc, 72(5), 986-988. https://doi.org/10.47391/JPMA.22-63.
• Sánchez-García, A., Rodriguez-Gutierrez, R., Mancillas-Adame, L., et al. (2020). Diagnostic Accuracy of the Triglyceride and Glucose Index for Insulin Resistance: A Systematic Review. Int J Endocrinol, 2020: 1-7. https://doi.org/10.1155/2020/4678526.
• Sánchez-Íñigo, L., Navarro-González, D., Pastrana-Delgado, J., Fernández-Montero, A., Martínez, J.A. (2016). Association of triglycerides and new lipid markers with the incidence of hypertension in a Spanish cohort. J Hypertens, 34(7), 1257-1265. https://doi.org/10.1097/HJH.0000000000000941.
• Simental-Mendía, L.E., Rodríguez-Morán, M.E., Guerrero-Romero, F. (2008). The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord, 6(4), 299. https://doi.org/10.1089/MET.2008.0034.
• Swislocki, A.L.M., Hoffman, B.B., Reaven, G.M. (1989). Insulin Resistance, Glucose Intolerance and Hyperinsulinemia in Patients with Hypertension. Am J Hypertens, 2(6_Pt_1), 419-423. https://doi.org/10.1093/ajh/2.6.419.
• Tohidi, M., Hatami, M., Hadaegh, F., Azizi, F. (2012). Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women. J Hum Hypertens, 26(9), 525-532. https://doi.org/10.1038/JHH.2011.70.
• Weber, M.A., Schiffrin, E.L., White, W.B., et al. (2014). Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich), 16(1), 14. https://doi.org/10.1111/JCH.12237.
• Williams, R.R., Hunt, S.C., Hopkins, P.N., et al. )1988). Familial dyslipidemic hypertension: evidence from 58 Utah families for a syndrome present in approximately 12% of patients with essential hypertension. Jama, 259(24), 3579-3586. https://doi.org/10.1001/JAMA.259.24.3579.
• Zheng, R., Mao, Y. (2017). Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis, 16(1), 175. https://doi.org/10.1186/s12944-017-0562-y.